Death rates for certain complex surgeries lower at teaching hospitals

February 09, 2004

CHICAGO - Death rates for some complex gastrointestinal surgical procedures are lower at teaching hospitals than at non-teaching hospitals, according to an article in the February issue of The Archives of Surgery, one of the JAMA/Archives journals.

According to the article, teaching hospitals are responsible for the training of surgical residents and, at university-affiliated centers, the education of medical students. Surgical residents and students participate in operations, and care for patients as they recover. Patients may be concerned that having surgical residents or medical students participate in their care may result in worse outcomes when compared to non-teaching hospitals.

Justin B. Dimick, M.D., of the University of Michigan Medical Center, Ann Arbor, and colleagues compared surgical outcomes at teaching and non-teaching hospitals and looked at the association between hospital volume and teaching status for three complex gastrointestinal surgical procedures.

The researchers examined data from patients undergoing esophageal resection (removal of part of the esophagus; n=1,247), hepatic resection (removal of part of the liver; n=2,073), or pancreatic resection (removal of part or all of the pancreas; n=3,337) during 1996 and 1997. They used hospital data collected by the American Hospital Association for 1997 to determine hospital volume and teaching status.

The researchers found that none of the procedures had higher death rates at teaching hospitals. Death rates for teaching hospitals vs. non-teaching hospitals for the procedures studied were as follows: for pancreatic resection, 4 percent vs. 8.8 percent; for hepatic resection, 5.3 percent vs. 8 percent; and for esophageal resection, 7.7 percent vs. 10.2 percent.

"The present study demonstrates that important clinical outcomes of complex surgery vary among hospitals with different organizational structures," the authors write. "Specifically, teaching hospitals have lower operative mortality rates for pancreatic, hepatic, and esophageal resections compared with non-teaching hospitals, but these differences can be attributed to higher volume at teaching hospitals. Further studies should concentrate on the structure and process variables, other than volume, that contribute to variation in outcomes between hospitals."
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(Arch. Surg. 2004;139:137-141. Available post-embargo at archsurg.com)

To contact co-author Gilbert R. Upchurch, Jr., M.D., call Nicole Fawcett at 734-764-2220.
For more information, contact JAMA/Archives Media Relations at 312-464-JAMA (5262) or e-mail mediarelations@jama-archives.org.

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